Is Flat Rate Charging Acceptable?

zavalag

New
Messages
8
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0
Hello,
Is a provider allowed to bill the same dollar amount for his office visits? I believe it is reference as "flat rate" billing. Codes 99201-99215 all bill at same amount regardless if have insurance or self pay.
Any restrictions with state, federal laws, Medicare, etc.? Note: the appropriate CPT code will be utilized based on level of service/documentation.

Does it make a difference if the provider charges $75.00 or $200.00 as a flat rate for each E/M level?

Thank you in advance,
GZ
 

ahefner

Networker
Messages
29
Location
Fort Walton Beach
Best answers
0
Hello,
Is a provider allowed to bill the same dollar amount for his office visits? I believe it is reference as "flat rate" billing. Codes 99201-99215 all bill at same amount regardless if have insurance or self pay.
Any restrictions with state, federal laws, Medicare, etc.? Note: the appropriate CPT code will be utilized based on level of service/documentation.

Does it make a difference if the provider charges $75.00 or $200.00 as a flat rate for each E/M level?

Thank you in advance,
GZ
Why in the world would a provider wish to do that? Even if you don't accept Medicare, it would well be worth the while to explain RVU's for the doctor and how pricing should work. Now you can't bill different rates to different people but this is nearly the antithesis of that! Check those insurance contracts and price accordingly. There are of course laws pertaining to Medicare, Tricare, and charges (115% for out of network etc.). Please research this some more and keep your physician from under valuing his service and putting you out work!
 

CodingKing

True Blue
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3,955
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What's the physicians angle on this? Why would this be something they want to do. It doesn't get you out of proper leveling and documentation like you mention above. Physician will also need to remember just because the rate is the same for a level 1 as a level 5, it doesn't decrease any liability should there be up coding and down coding issues. I cant think of any other reason why the provider would want to do this.
 

Walker22

True Blue
Messages
697
Location
Atlanta, Ga.
Best answers
0
What's the physicians angle on this? Why would this be something they want to do. It doesn't get you out of proper leveling and documentation like you mention above. Physician will also need to remember just because the rate is the same for a level 1 as a level 5, it doesn't decrease any liability should there be up coding and down coding issues. I cant think of any other reason why the provider would want to do this.
Having worked in a physician's office for many years, I think I can guess why he/she would want to do this. Patients do not understand that there are different levels of office visit depending on the work done. To them, they all seem the same, so they get irate when the charge for one is more than the charge for another.
 
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